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former farm worker in Venezuela until 2001&#44; presented with a single back ulcerated lesion&#44; with a 2-month evolution &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; He had no other complaints and his clinical background was unremarkable&#44; except for a previous ulcerated lesion of the nasal mucosa in 1996&#44; for which he had had an unspecified 6-month treatment&#46; His general condition was normal&#44; without fever&#44; palpable lymphadenopathy or hepatosplenomegaly&#46; There were no laboratory changes&#44; results for HIV 1 and 2 were negative&#46; Bilateral diffuse changes in pulmonary auscultation were noticed and a chest radiograph was performed&#44; showing a bilateral reticulo-nodular pattern predominantly in the middle and upper lung zones and a segmental consolidation in the right lung base&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pulmonary HRCT revealed exuberant bilateral parenchymal lesions with fibrotic changes and areas of active inflammatory disease mostly affecting the middle and upper lobes&#44; 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followed by 100<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 8 months&#41; was performed&#44; with favorable clinical course&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">PCM was initially described by a Brazilian doctor&#44; Lutz&#44; in 1908&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is the most common endemic mycosis in Latin America&#46; Brazil has the highest number of cases&#59; it is most prevalent in subtropical regions where it affects about 10&#37; of the population&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is a systemic granulomatous disease&#44; predominantly pulmonary and mucocutaneous&#46; The lungs are involved in 50&#8211;100&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The main route of infection is by inhalation of <span class="elsevierStyleItalic">PB</span> spores which are present in the soil&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;7&#44;8</span></a> The host&#39;s initial contact with the fungus usually progresses to a subclinical infection&#44; with formation of a pulmonary granuloma&#44; which may resemble the primary complex of tuberculosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In most individuals the natural defense mechanisms provide a balance between the host and the agent&#44; with the fungus remaining viable in a latent form&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4&#44;6</span></a> Spread to other organs and tissues may occur&#44; most often to the skin and the mucosa of the airway and the oral cavity&#44; with formation of granulomatous hemorrhagic ulcerated lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Two clinical forms have been described&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">an acute&#47;subacute or juvenile type&#44; accounting for less than 10&#37; of cases&#44; affecting both sexes under the age of 25 years&#44; with fever&#44; weight loss and malaise&#46; There is rapid and progressive organ involvement with diffuse superficial and deep lymphadenopathy and hepatosplenomegaly&#46; In a small number of cases cutaneous and osteolytic lesions coexist&#46; The small intestine is involved in about 50&#37; of cases&#46; There is rarely involvement of the lung and bone marrow&#46; The most common complications are lymphatic obstruction&#44; intestinal malabsorption or protein-losing enteropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">a chronic form that arises primarily in adult males &#40;male &#47; female ratio of 10&#58;1&#8211;25&#58;1&#41;&#44; 25&#8211;60 years old&#44; most often involving the lung&#44; followed by skin and mucous membranes&#46; Patients may be asymptomatic or present with dyspnea&#44; cough and occasionally hemoptysis&#46; Fever is rare and the physical examination is often normal&#46; This lack of respiratory symptoms may be paradoxical compared to the exuberance of pulmonary lesions&#46; Morbidity results especially from the development of respiratory failure and cor pulmonale&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;6</span></a> Spontaneous pneumothorax is rarely the first clinical manifestation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">The chest radiograph in PB infection may reveal linear and reticular opacities&#44; differently-sized nodules&#44; poorly defined infiltrates&#44; areas of airspace consolidation and cavitation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This examination&#44; however&#44; has limited capacity for evaluating diffuse lung disease so HRCT has become the preferred method for evaluating patients with clinical suspicion and &#47; or laboratory evidence of pulmonary PCM&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The changes in the lung parenchyma usually display a bilateral symmetric distribution&#44; affecting the whole lung but predominantly the middle and upper lobes&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> Both active phase injuries and chronic fibrotic changes may be found simultaneously&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Lung disease is manifested on HRCT by consolidation&#44; &#8216;ground glass&#8217; opacities&#44; scattered parenchymal nodules &#40;granulomas or paracoccidiomas&#41;&#44; septal thickening&#44; spiculated pleural thickening&#44; bronchial wall thickening&#44; traction bronchiectasis&#44; tracheal dilation&#44; architectural distortion&#44; parenchymal bands&#44; and paracicatricial emphysema&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> Hilar and mediastinal lymphadenopathy are often present&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Parenchymal consolidation represents a focal pneumonia&#44; which usually starts with a desquamative alveolitis &#40;associated with &#8216;ground glass&#8217; opacities&#41; and consists of an inflammatory infiltrate rich in fungi&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The &#8216;reversed halo&#8217; sign &#40;central &#8216;ground glass&#8217; pattern surrounded by crescent or ring-shaped peripheral consolidation&#41;&#44; appears in about 10&#37; of patients with active infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Granulomas are characterized by irregular&#44; spiculated margins and variable dimensions&#44; assuming bizarre forms and a tendency to confluence&#46; Cavitation is common&#44; reflecting exudative inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Pulmonary fibrosis is a common finding reflected by thickening of inter and intralobular septa&#44; thickening of bronchial walls&#44; architectural distortion&#44; parenchymal bands and irregular thickening of the perihilar axial interstitium&#44; involving hilar lymph nodes and main bronchi and pulmonary artery branches&#46; This may be responsible for the development of cor pulmonale&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#8211;10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The definitive diagnosis of this mycosis is obtained where PB is observed in biological fluids or tissues&#44; mainly by direct mycological and&#47;or histological examination or by serological techniques &#40;antibody titers&#41; that are also useful in assessing response to treatment and detection of recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Active clinical disease can be treated with trimethoprim-sulfometoxazol or itraconazole&#46; The most severe cases of chronic or acute illness can be treated with amphotericin B&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;12&#44;13</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Although uncommon in everyday clinical practice&#44; PCM should be considered as a diagnostic hypothesis when there has been potential exposure&#44; even if not recent&#44; in endemic areas&#46; High Resolution CT is essential for diagnosing these patients&#44; as it accurately assesses the degree of lung parenchymal involvement&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Paracoccidioidomycosis"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paracoccidioidomycosis is a systemic mycosis which is endemic in rural areas of Latin America&#44; an important European source of immigrants and a growing European touristic destination as well&#44; with most cases occurring in Brazil&#44; Argentina&#44; Venezuela and Colombia&#46; The authors report a case of a 43-year-old man who previously worked in Venezuela and is living in Portugal for 8 years&#44; presenting with a single cutaneous lesion&#46; Despite the absence of valuable respiratory complaints&#44; severe lung damage was found with high-resolution computed tomography &#40;HRCT&#41;&#46; Biopsy of the cutaneous lesion and mycologic sputum examination were performed revealing <span class="elsevierStyleItalic">Paracoccidioides brasiliensis</span> infection&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A Paracoccidioidomicose &#233; uma micose sist&#233;mica end&#233;mica nas &#225;reas rurais da Am&#233;rica Latina&#44; uma fonte importante de imigrantes e destino de emigra&#231;&#227;o e turismo europeu&#44; a maioria dos casos ocorrendo no Brasil&#44; Argentina&#44; Venezuela e Col&#244;mbia&#46; Os autores descrevem o caso cl&#237;nico de um paciente com 43 anos&#44; anteriormente emigrado na Venezuela e residente em Portugal h&#225; 8 anos&#44; que se apresenta com les&#227;o cut&#226;nea isolada&#46; Embora sem queixas relevantes do foro respirat&#243;rio&#44; apresentava extensas les&#245;es do par&#234;nquima pulmonar caracterizadas por tomografia computorizada de alta resolu&#231;&#227;o &#40;TCAR&#41;&#46; Foi realizada bi&#243;psia da les&#227;o cut&#226;nea e exame micol&#243;gico da expetora&#231;&#227;o que revelaram infe&#231;&#227;o por <span class="elsevierStyleItalic">Paracoccidioides brasiliensis</span> &#40;PB&#41;&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Armas&#44; M&#59; Paracoccidioidomicose pulmonar&#58; relato de caso cl&#237;nico com aspectos em tomografia computorizada de alta resolu&#231;&#227;o&#46; Rev Port Pneumol 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.rppneu.2012.02.001">doi&#58;10&#46;1016&#47;j&#46;rppneu&#46;2012&#46;02&#46;001</span>&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pulmonary HRCT findings&#46; Left&#58; Middle lobe consolidation with air broncogram and architectural distortion&#46; Scattered &#8216;ground glass&#8217; pattern through the left lung&#46; Bilateral granulomas&#44; some with cavitation &#40;arrows&#41;&#46; Mediastinal pleura spiculated thickening&#46; Right&#58; Right upper lobe paracicatricial enphysema and cavitation&#46; Left lung parenchymal band &#40;arrow&#41; and interlobular septal thickening&#46;</p>"
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Case report
Pulmonary paracoccidioidomycosis: A case report with high-resolution computed tomography findings
Paracoccidioidomicose pulmonar: relato de caso clínico com alterações na tomografia computorizada de alta resolução
M. Armasa,
Corresponding author
mncarmas@yahoo.com

Corresponding author.
, C. Ruivob, R. Alvesc, M. Gonçalvesa, L. Teixeirab
a Serviço de Radiologia, Hospital Central do Funchal, Funchal, Portugal
b Serviço de Radiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal
c Serviço de Dermatologia, Hospital Central do Funchal, Funchal, Portugal
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        "titulo" => "Paracoccidioidomicose pulmonar&#58; relato de caso cl&#237;nico com altera&#231;&#245;es na tomografia computorizada de alta resolu&#231;&#227;o"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Back ulcerated lesion&#44; with a 2-month evolution&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Paracoccidioidomycosis &#40;PCM&#41; is the most common endemic systemic mycosis in Latin America&#46; It occurs in about 10&#37; of the population in the subtropical regions of Brazil&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and mostly affects farm workers&#59; the highest incidence happens between the ages of 25 and 60&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The causing agent&#44; <span class="elsevierStyleItalic">Paracoccidioides brasiliensis</span> &#40;PB&#41;&#44; is a dimorphic fungus that can remain viable in the host for long periods&#44; maintaining the potential for disease reactivation for several years after the initial infection&#46; The portal of entry is the respiratory tract&#44; the lung being the organ which is most frequently affected&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chronic infection with severe lung damage and progression to end-stage fibrosis occurs even where there are no obvious symptoms&#46; Spread from a primary pulmonary lesion may affect other organs&#44; not only the skin and mucous membranes most often&#44; but also the adrenal glands&#44; kidneys&#44; gastrointestinal tract&#44; liver&#44; spleen and central nervous system&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> The most common sequelae include fibrosis with respiratory failure&#44; cor pulmonale and also Addison&#39;s disease and intestinal malabsorption&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The authors present a case of PCM with pulmonary and cutaneous involvement&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 43-year-old Portuguese male&#44; former farm worker in Venezuela until 2001&#44; presented with a single back ulcerated lesion&#44; with a 2-month evolution &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; He had no other complaints and his clinical background was unremarkable&#44; except for a previous ulcerated lesion of the nasal mucosa in 1996&#44; for which he had had an unspecified 6-month treatment&#46; His general condition was normal&#44; without fever&#44; palpable lymphadenopathy or hepatosplenomegaly&#46; There were no laboratory changes&#44; results for HIV 1 and 2 were negative&#46; Bilateral diffuse changes in pulmonary auscultation were noticed and a chest radiograph was performed&#44; showing a bilateral reticulo-nodular pattern predominantly in the middle and upper lung zones and a segmental consolidation in the right lung base&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pulmonary HRCT revealed exuberant bilateral parenchymal lesions with fibrotic changes and areas of active inflammatory disease mostly affecting the middle and upper lobes&#44; despite the absence of respiratory symptoms&#46; Multiple irregular spiculated nodular lesions ranging from 8 to 25<span class="elsevierStyleHsp" style=""></span>mm in size were identified&#44; some with central cavitation and confluence&#59; these were most conspicuous in the upper lobes&#46; Other findings included a central area of consolidation with air bronchogram in the middle lobe&#44; architectural distortion&#44; scattered foci of &#8216;ground glass&#8217; attenuation&#44; septal thickening&#44; parenchymal bands&#44; diffuse pleural speculated thickening&#44; apical emphysematous bubbles and traction bronchiectasis&#46; Hilar adenopathy and parietal irregularity of a dilated trachea were also present &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Biopsy of skin lesions and mycological examination of sputum revealed infection by <span class="elsevierStyleItalic">Paracoccidioides brasiliensis</span> &#40;PB&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Therapy with itraconazole &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 2 months&#44; followed by 100<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 8 months&#41; was performed&#44; with favorable clinical course&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">PCM was initially described by a Brazilian doctor&#44; Lutz&#44; in 1908&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is the most common endemic mycosis in Latin America&#46; Brazil has the highest number of cases&#59; it is most prevalent in subtropical regions where it affects about 10&#37; of the population&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is a systemic granulomatous disease&#44; predominantly pulmonary and mucocutaneous&#46; The lungs are involved in 50&#8211;100&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The main route of infection is by inhalation of <span class="elsevierStyleItalic">PB</span> spores which are present in the soil&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;7&#44;8</span></a> The host&#39;s initial contact with the fungus usually progresses to a subclinical infection&#44; with formation of a pulmonary granuloma&#44; which may resemble the primary complex of tuberculosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In most individuals the natural defense mechanisms provide a balance between the host and the agent&#44; with the fungus remaining viable in a latent form&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4&#44;6</span></a> Spread to other organs and tissues may occur&#44; most often to the skin and the mucosa of the airway and the oral cavity&#44; with formation of granulomatous hemorrhagic ulcerated lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Two clinical forms have been described&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">an acute&#47;subacute or juvenile type&#44; accounting for less than 10&#37; of cases&#44; affecting both sexes under the age of 25 years&#44; with fever&#44; weight loss and malaise&#46; There is rapid and progressive organ involvement with diffuse superficial and deep lymphadenopathy and hepatosplenomegaly&#46; In a small number of cases cutaneous and osteolytic lesions coexist&#46; The small intestine is involved in about 50&#37; of cases&#46; There is rarely involvement of the lung and bone marrow&#46; The most common complications are lymphatic obstruction&#44; intestinal malabsorption or protein-losing enteropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">a chronic form that arises primarily in adult males &#40;male &#47; female ratio of 10&#58;1&#8211;25&#58;1&#41;&#44; 25&#8211;60 years old&#44; most often involving the lung&#44; followed by skin and mucous membranes&#46; Patients may be asymptomatic or present with dyspnea&#44; cough and occasionally hemoptysis&#46; Fever is rare and the physical examination is often normal&#46; This lack of respiratory symptoms may be paradoxical compared to the exuberance of pulmonary lesions&#46; Morbidity results especially from the development of respiratory failure and cor pulmonale&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;6</span></a> Spontaneous pneumothorax is rarely the first clinical manifestation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">The chest radiograph in PB infection may reveal linear and reticular opacities&#44; differently-sized nodules&#44; poorly defined infiltrates&#44; areas of airspace consolidation and cavitation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This examination&#44; however&#44; has limited capacity for evaluating diffuse lung disease so HRCT has become the preferred method for evaluating patients with clinical suspicion and &#47; or laboratory evidence of pulmonary PCM&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The changes in the lung parenchyma usually display a bilateral symmetric distribution&#44; affecting the whole lung but predominantly the middle and upper lobes&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> Both active phase injuries and chronic fibrotic changes may be found simultaneously&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Lung disease is manifested on HRCT by consolidation&#44; &#8216;ground glass&#8217; opacities&#44; scattered parenchymal nodules &#40;granulomas or paracoccidiomas&#41;&#44; septal thickening&#44; spiculated pleural thickening&#44; bronchial wall thickening&#44; traction bronchiectasis&#44; tracheal dilation&#44; architectural distortion&#44; parenchymal bands&#44; and paracicatricial emphysema&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> Hilar and mediastinal lymphadenopathy are often present&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Parenchymal consolidation represents a focal pneumonia&#44; which usually starts with a desquamative alveolitis &#40;associated with &#8216;ground glass&#8217; opacities&#41; and consists of an inflammatory infiltrate rich in fungi&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The &#8216;reversed halo&#8217; sign &#40;central &#8216;ground glass&#8217; pattern surrounded by crescent or ring-shaped peripheral consolidation&#41;&#44; appears in about 10&#37; of patients with active infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Granulomas are characterized by irregular&#44; spiculated margins and variable dimensions&#44; assuming bizarre forms and a tendency to confluence&#46; Cavitation is common&#44; reflecting exudative inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Pulmonary fibrosis is a common finding reflected by thickening of inter and intralobular septa&#44; thickening of bronchial walls&#44; architectural distortion&#44; parenchymal bands and irregular thickening of the perihilar axial interstitium&#44; involving hilar lymph nodes and main bronchi and pulmonary artery branches&#46; This may be responsible for the development of cor pulmonale&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#8211;10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The definitive diagnosis of this mycosis is obtained where PB is observed in biological fluids or tissues&#44; mainly by direct mycological and&#47;or histological examination or by serological techniques &#40;antibody titers&#41; that are also useful in assessing response to treatment and detection of recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Active clinical disease can be treated with trimethoprim-sulfometoxazol or itraconazole&#46; The most severe cases of chronic or acute illness can be treated with amphotericin B&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;12&#44;13</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Although uncommon in everyday clinical practice&#44; PCM should be considered as a diagnostic hypothesis when there has been potential exposure&#44; even if not recent&#44; in endemic areas&#46; High Resolution CT is essential for diagnosing these patients&#44; as it accurately assesses the degree of lung parenchymal involvement&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paracoccidioidomycosis is a systemic mycosis which is endemic in rural areas of Latin America&#44; an important European source of immigrants and a growing European touristic destination as well&#44; with most cases occurring in Brazil&#44; Argentina&#44; Venezuela and Colombia&#46; The authors report a case of a 43-year-old man who previously worked in Venezuela and is living in Portugal for 8 years&#44; presenting with a single cutaneous lesion&#46; Despite the absence of valuable respiratory complaints&#44; severe lung damage was found with high-resolution computed tomography &#40;HRCT&#41;&#46; Biopsy of the cutaneous lesion and mycologic sputum examination were performed revealing <span class="elsevierStyleItalic">Paracoccidioides brasiliensis</span> infection&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A Paracoccidioidomicose &#233; uma micose sist&#233;mica end&#233;mica nas &#225;reas rurais da Am&#233;rica Latina&#44; uma fonte importante de imigrantes e destino de emigra&#231;&#227;o e turismo europeu&#44; a maioria dos casos ocorrendo no Brasil&#44; Argentina&#44; Venezuela e Col&#244;mbia&#46; Os autores descrevem o caso cl&#237;nico de um paciente com 43 anos&#44; anteriormente emigrado na Venezuela e residente em Portugal h&#225; 8 anos&#44; que se apresenta com les&#227;o cut&#226;nea isolada&#46; Embora sem queixas relevantes do foro respirat&#243;rio&#44; apresentava extensas les&#245;es do par&#234;nquima pulmonar caracterizadas por tomografia computorizada de alta resolu&#231;&#227;o &#40;TCAR&#41;&#46; Foi realizada bi&#243;psia da les&#227;o cut&#226;nea e exame micol&#243;gico da expetora&#231;&#227;o que revelaram infe&#231;&#227;o por <span class="elsevierStyleItalic">Paracoccidioides brasiliensis</span> &#40;PB&#41;&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Armas&#44; M&#59; Paracoccidioidomicose pulmonar&#58; relato de caso cl&#237;nico com aspectos em tomografia computorizada de alta resolu&#231;&#227;o&#46; Rev Port Pneumol 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.rppneu.2012.02.001">doi&#58;10&#46;1016&#47;j&#46;rppneu&#46;2012&#46;02&#46;001</span>&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pulmonary HRCT findings&#46; Left&#58; Middle lobe consolidation with air broncogram and architectural distortion&#46; Scattered &#8216;ground glass&#8217; pattern through the left lung&#46; Bilateral granulomas&#44; some with cavitation &#40;arrows&#41;&#46; Mediastinal pleura spiculated thickening&#46; Right&#58; Right upper lobe paracicatricial enphysema and cavitation&#46; Left lung parenchymal band &#40;arrow&#41; and interlobular septal thickening&#46;</p>"
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